Chapter 22 Antihypertensive Drugs

Question 1

Blood pressure

Answer 1

Is determined by the product of cardiac output and systemic vascular resistance.
(CO x SV = BP)

Question 2

Prehypertension

Answer 2

Defined as having a systolic blood pressure between 120 and 139 mm Hg and a diastolic pressure between 80 and 89 mm Hg.

Question 3

When should anti hypertensive therapy be started?

Answer 3

If BP is greater than or equal to 150/90 for pt’s older than 60 and 140/90 for pt’s younger than 60 and those who have chronic kidney disease or diabetes.

Question 4

Unknown cause of hypertension: other names for it.

Answer 4

Essential
Idiopathic
Primary

90% of cases have an unknown cause

Question 5

Known cause of hypertension: name

Answer 5

Secondary hypertension

10% of cases

Question 6

Methyldopa (Aldomet)

Answer 6

Adrenergic drug that results in decreased BP.
Usually used after other drugs have failed because of adverse effects.

Adverse effects:
Orthostatic hypotension
A pt who is starting alpha 1 receptor agonists should take first dose while lying down because there is a first-dose hypotensive effect with this medication.

Question 7

ACE inhibitors

Angiotensin converting enzyme inhibitors

Answer 7

End is “opril “ “ipril”
First line of drugs used for HF & Hypertension.
Renal protective effects in pt’s with diabetes
Prodrugs except Catopril and Lisinopril
Catopril and Lisinopril can be given to pt’s that have liver dysfunction, unlike other ACE inhibitors that are prodrugs.

Question 8

ACE inhibitor adverse effects

Answer 8

Dry, nonproductive cough which is usually reversed when therapy stops.
If angioedema occurs the patient should seek medical attention.
For those hypotensive effect may occur.
NSAID’s can reduce the anti hypertensive effects of ACE inhibitors. Can also predispose pt’s to develop acute renal failure.
ACE inhibitors can cause renal impairment which can be identified with serum creatinine. WATCH KIDNEY LABS VERY CLOSELY.
ACE inhibitors can cause hyperkalemia, so potassium levels need to be monitored.

Question 9

Angiotensin II receptor blockers

ARB’s

Answer 9

Have “sartan “ in the drug names
Well tolerated, do not cause dry cough.
They effect primarily vascular smooth muscle and the adrenal gland.

Question 10

Calcium Channel Blockers

CCB’s

Answer 10

Treatment of hypertension and angina

Able to cause smooth muscle relaxation.

Question 11

Diuretics

Answer 11

Used to decrease plasma and extra cellular fluid volumes
Decrease the workload of the heart
Thiazide diuretics (hydrochlorothiazide) are the most commonly used diuretics for tx of hypertension.
According to JNC 8 guidelines, CCB’s and diuretics have been shown to be more effective in African American than in white pt’s.
Thiazide diuretics are also recommended for newly diagnosed stage 1 hypertension.

Question 12

Vasodilators

Answer 12

Tx for hypertension, may be used in combination with other drugs
Sodium nitroprusside is a potent vasodilator and may lead to extreme decreases in the pt’s BP. For this reason it is never infused at the maximum dose for more than 10 minutes. If this drug does not control a pt’s BP after 10 min, it will most likely be discontinued. Reserved for the management of hypertensive emergencies.